Although individuals may seeks and receive medical treatment for RA, medical treatment cannot always prevent or alleviate the effects of the disease. In addition, there are aspects of the disease that are managed by the individual without medical intervention. The result is that RA has the potential to present serious challenges, or stresses, for the individual. The overarching aims of this project are to determine how people with RA deal with the stresses of the disease, and how disease management and self-care behaviors are associated with outcomes. The proposed research will address these issues using a modification of the Folkman and Lazarus model of stress, appraisal, and coping. Simply described, the model postulates that, following the introduction of an RA stressor, and individual makes certain judgement and resources, and produce coping or adaptive responses to the RA stressor, which then influence both specific outcomes (i.e., activity losses or modifications) as well as more general outcomes such as function, psychosocial well- being, and health service utilization. This project will focus on seven stressors that may be associated with RA or its treatment: pain, fatigue, changes in physical appearance, unpredictability of symptoms, chronicity of the disease and its treatment, side effects of medications, and functional impairment. We will examine the degree to which persons with RA perceive each of these potential stressors as problems, the impact of the stressors, what individuals do to manage or cope with the stressors, and how effective they feel their coping efforts are. Taking this information one step farther, we will also examine how these management, coping, and self-care behaviors are from the RA Panel Study. 628 persons remain in the panel, and approximately 250 persons with newly diagnosed R will be added during the first year of this cycle. All of these individuals will be followed over the five-year study period. Establishment of the relationship of management and coping responses to outcomes is essential if effective responses are to be identified. The results of this study should provide a better understanding of how individuals' multifaceted responses to RA influence health, psychosocial, and health service utilization outcomes. More comprehensive knowledge of the perceptions of these stressors and effective management and coping responses can then be incorporated into patient education programs and into clinical contacts with persons with RA by health professionals, with the goal of improving individuals' ability to deal with RA, thereby improving their quality of life.